LABOR AND DELIVERY  80 diameter of Inlet – 11

LABOR  Transverse Diameter of Inlet – 13

– Expulsion of all the products of conception – CERVICAL CANAL:
– Length of Gestation: 9 months – 37 to 42 weeks – 280 days  Effacement at Internal OS, thinning
– There are Four (4) hormones that will start the contractions/labor:  Dilatation of External OS, widening
Oxytocin, Prostaglandin, Estrogen, Fetal Cortisol – VAGINAL CANAL: The ability to distend
 When the level of Progesterone is High the four Hormone is Low, the
women will not undergo Labor and Delivery ANTERIOR – POSTERIOR TRANSVERSE DIAGONAL
 PROGESTERONE: Hormone that will prevent contraction
Inlet 11 cm 13 cm 12 cm
 OXYTOCIN: The number one Hormone that will stimulate uterine
Cavity 12 cm 12 cm 12 cm
contractions coming from Posteriori Pituitary Gland (PPG)
Outlet 13 cm 11 cm 12 cm
 PROLACTIN: Coming from the Anterior Pituitary Gland (APG)

DURATION OF LABOR 3. POWER

 PRIMIPARA: Experiences earlier from 1 to 2 weeks ,14 hours not more than 20 – before Labor: 0% Effacement
hours – 30% Early Effacement
 MULTIPARA: Experiences faster from 1 to 2 days, 8 hours not more than 14 hours – 100% Complete Effacement
– Complete Dilatation
PRELIMINARY SIGNS OF LABOR  Factors that will affect Labor and Delivery
1. LIGHTENING: The dropping of the baby, entrance of the Fetal Presenting – Fetus: Normal:
Part (head, shoulder, buttocks) unto the Pelvic Inlet – 1 per pregnancy
– No Lightening at 9th month, the Fundus is ay Xiphoid Process – 2 fetuses, abnormal Fetal Presentation
– Lightening late 9th month, slight below the Xiphoid Process (8th – Side: 2.5 kg – 3 kg – 4 kg
month level) – Attitude: Flexion
– Lightening occurs because of Progesterone and Relaxin – the – Presentation: Cephalic
loosening of Pelvic Joints – Position: LOA, ROA, OA
– Shortness of Breathing (SOB) is relieved when there is Lightening as – Lie: Longitudinal
the pressure is below and urinary bladder is compressed which causes – Presenting Part: Vertex/Occiput
Urinary Frequency
2. Sudden Weight Loss 4. PSYCHOLOGICAL RESPONSE/PSYCHE
3. Increase of Tension and Fatigue/Activity Level – The Mental, Psychological, and Emotional preparation of the woman to
4. Cervical Changes undergo labor and delivery
5. Ripening of Cervix  Companion of Choice (COC): Provide continuous maternal support
6. Rupture of Bag of Water (BOW)  Regular Pre – Natal check ups
7. NESTING BEHAVIOR: The woman is busy preparing the materials to be used
8. BRAXTON HICKS CONTRACTIONS: Painless, Irregular contractions because 5. PLACENTAL FACTOR
there is high level of Estrogen during pregnancy but Progesterone is higher – PLACENTA PREVIA: Problem is in the location of Placenta
– If near labor, the Progesterone is decreasing, Estrogen and Oxytocin – ABRUPTIO PLACENTA: Problem is the timing of Separation
are increasing – that is why the Braxton Hicks Contractions (BHC)
FOUR (4) STAGES OF LABOR
becomes painful and irregular
STAGE 1: DILATATION STAGE
– It begins with the onset of true uterine contractions and ends when the cervix is
TRUE LABOR fully dilated
1. Pain originates at the Lumbo Sacral Area – Monitor the progress of Labor using the table
2. Pain is intensified by walking – The best time for Health Teaching for proper pushing is Latent Phase because the
3. Negative (–) BOW: Ruptured mother is cooperative
4. Contractions not affected by sedation
5. Contractions are progressive or regular THREE (3) PHASES:
6. There are cervical changes 1. LATENT PHASE: 0 to 3 cm dilated
 Effacement at Internal OS, thinning 2. ACTIVE PHASE: 4 to 7 cm dilated
 Dilatation of External OS, widening 3. TRANSITION PHASE: 8 to 10 cm dilated
7. No bloody show
 ASSESSING FETAL ENGAGEMENT AND STATION: Relationship of the presenting
FALSE LABOR part to the ischial spine and denoted in centimeters
1. Pain originates form the abdomen
2. Pain is relieved by waling FETAL POSITION
 LOA: Most common and favorable birthing position
3. Intact Bag of Water (BOW)
 LOP AND ROP: Most common malposition and most painful as well
4. Sedation decreases contraction’s
5. Contractions are non – progressive and irregular STAGE 2: EXPULSION/DELIVERY OF THE BABY
6. There are NO cervical changes – Which encompasses the actual birth, begins when the cervix is fully dilated and
7. Presence of bloody show ends with the delivery of the fetus

CRITERIA TRUE FALSE CARDINAL MOVEMENTS/MECHANISM OF LABOR

Frequency of contractions Regular Irregular D – DESCENT E – EXTENSION
Intensity of contractions Increases No increase F – FLEXION ER – EXTERNAL ROTATION
Pain relief Pain is intensified by Pain is relieved by IR – INTERNAL ROTATION E – EXPULSION
walking walking
Pain location Begins on lower back and Confined on STAGE 3: PLACENTAL STAGE
radiates to abdomen abdomen – It begins immediately after the neonate is delivered and ends when the placenta
Cervical Changes Effacement and dilation No cervical changes is delivered

SIGNS OF PLACENTAL SEPARATION

FACTORS AFFECTING LABOR & DELIVERY:
 Rising of fundus
1. PASSENGER (FETUS)
 Calkin's Sign
– The forces that push the baby out
 Sudden gush of blood
– CONTRACTION: Main source of power during labor and delivery caused by  Lengthening of the cord
Oxytocin coming from Posterior Pituitary Gland (PPG) – Controlled Cord Traction with Counter Traction (CCTCT)
– Originate sin the Myometrium of the Fundus at the upper uterine segment
STAGE 4: RECOVERY STAGE
2. PASSAGEWAY – It begins after delivery of the placenta and the 1st four hours after delivery
– This pertains to the birth canal
– PELVIS: Gynecoid followed by Anthropoid (11 – 12 – 13)
 ESSENTIAL INTRAPARTAL NEWBORN CARE (EINC)
A program by Department of Health (DOH) in full support of
World Health Organization (WHO)
Administrative Order 2009 – 0025 – December 2009
 The EINC initiative of the Philippine Department of Health–
Non–Communicable Diseases Prevention and Control–Family
Health Office (DOH–NCDPC–FHO) and DOH Center for Health
Promotions (NCHP), supported by the Joint Programme on
Maternal and Neonatal Health (JPMNH), and being funded
by AusAID, was piloted in 11 hospitals in the Philippines, and
has yielded favorable results
– Originally Essential Newborn Care (ENC)
– It aims to decrease both Maternal and neonatal
morbidity and mortality rates by 40%
 Maternal is 20% achieved
 Neonatal is 40% achieved
– It answers MDG 4: Child Health and MDG 5: Maternal
Health
– Evidence–based standards for safe quality care of
birthing mothers and their newborns within 48 hours of
intrapartum period and a week of life for the newborn
THE RECOMMENDED EINC PRACTICES DURING THE
INTRAPARTUM PERIOD INCLUDE:
– Continuous maternal support by having a companion of
choice during L/D.
– Freedom of movement during labor,
– Monitoring progress of labor using the Partograph,
– Non–drug pain relief before offering labor anesthesia,
– Position of choice during labor and delivery,
– Spontaneous pushing in a semi-upright position,
– Non – routine episiotomy,
– Active management of the 3rd Stage of labor (AMTSL)
– For newborns, four core steps were recommended in a time
bound sequence. A social marketing handle, “The First
Embrace,” accompanied the initiative for practice change
among health workers
ESSENTIAL INTRAPARTAL NEWBORN CARE (EINC)
1. IMMEDIATE DRYING: Using a clean, dry cloth, thoroughly
dry the baby, wiping the face, eyes, head, front and back,
arms and legs
2. SKIN–TO–SKIN CONTACT: Place the newborn prone on the
mother’s skin abdomen or chest skin–to–skin
3. NON–SEPARATION OF BABY FROM MOTHER: Observe the
newborn. Counsel on positioning and attachment. Initiate
breastfeeding
4. PROPER CORD CLAMPING:
EINC PURPOSES:
1. Assess and evaluate the newborn as he or she transitions
from intrauterine life to extrauterine life
2. Evaluate and monitor the newborn, system-by- system for
normal versus abnormal functioning, providing
maintenance of normal and potential treatment of
abnormal findings
3. Foster bonding between infant and parent/s
4. Provide a safe environment at all times
EINC PRACTICES DURING INTRAPARTUM PERIOD
 Continuous maternal support, by a companion of her
choice, during labor and delivery
 Mobility during labor – the mother is still mobile, within
reason, during this stage
 Position of choice during labor and delivery
 Non–drug pain relief, before offering labor anesthesia
 Spontaneous pushing in a semi-upright position
 Episiotomy will not be done, unless necessary
 Active management of third stage of labor
 Monitoring the progress of labor with the use of partograph
EINC: 4 TIME – BOUND INTERVENTIONS
 PROTOCOL: Immediate & thorough drying of newborn for
1st 30 secs
 RATIONALE: It prevents hypothermia which is extremely
important to a newborn’s survival
 PROTOCOL: Early & uninterrupted skin to skin contact
 RATIONALE: It prevents hypothermia, hypoglycemia &
sepsis. Increases colonization with protective bacterial flora
& improved bonding/breastfeeding initiation & exclusivity
 PROTOCOL: Properly–Timed Cord Clamping & Cutting after
1 to 3 minutes or until cord pulsation stops
 RATIONALE: It decreases anemia in 1 out of 7 term babies
and in 1out of 3 preterm babies. It prevents brain
(intraventricular) hemorrhage in 1 out of 2 preterm babies
 PROTOCOL: Non–Separation of the newborn from the
mother for early breastfeeding initiation & rooming–in for
90 minutes
 RATIONALE: Breastfeeding within the 1st 4 hour of life
prevents 19.1% of neonatal deaths
PERINEAL BULGING WITH PRESENTING PART VISIBLE
1. Prepare for the Delivery
2. Check temperature of the delivery room (25 – 28 ºC)
3. Notify appropriate staff /team
4. Arrange needed supplies in linear sequence
5. Check resuscitation equipment
6. Wash hands with clean water and soap
7. Double glove just before delivery
– NO routine episiotomy!
– NO Fundal pressure!
A. IMMEDIATE AND THOROUGH DRYING
30 seconds
1. Call the time of birth
2. Using a clean dry cloth, dry the newborn thoroughly for at
least 30 seconds
3. Wipe the eyes, face, head, front and back, arms and legs
4. Remove wet cloth
5. Do a quick check of breathing while drying (APGAR 1st
minute)
– DO NOT wipe off vernix caseosa
– DO NOT bathe the newborn
– DO NOT do foot printing
– NO hanging upside –down
– NO slapping
– NO squeezing of chest
– DO NOT suction unless the mouth or nose is blocked
B. EARLY SKIN–TO–SKIN CONTACT
after 30 seconds of Immediate Drying
1. Position the newborn prone on the mother’s abdomen or
chest
2. Cover the newborn’s back with dry blanket – DO NOT give sugar water. Formula, prelacteals
3. Cover the newborn’s head with bonnet – DO NOT give bottles or pacifiers
4. Place identification band on ankle 6. Examine newborn for birth injuries, malformations or
5. If newborn is crying and breathing normally avoid any defects
manipulation, ex: routine suctioning that may cause trauma 7. Postpone washing until 6 hours
or infection 8. Minimize handling by health workers

C. PROPERLY–TIMED CORD CLAMPING AND CUTTING 4 MEDICATIONS FOR NEWBORN

3 minutes 1. Administer Erythromycin, tetracycline or 2.5% povidone
1. Remove the first set of gloves drops (to prevent ophthalmia neonatorum)
2. Hold the cord and feel the pulsation 2. Inject Vitamin K 1mg, IM as prophylaxis
3. After umbilical pulsations have stopped (typically at 1 to 3 3. Inject Hepa B vaccine via IM
minutes) 4. Inject BCG vaccine via ID
– With a sterile plastic clamp or tie, clamp the cord at 2
cm from/above the umbilical base EARLY AND APPROPRIATE BREASTFEEDING INITIATION
– Clamp again at 5 cm using Kelly Clamp from/above the  Help the mother & baby into a comfortable position
base  Observe the newborn for feeding cues
– Thereafter, provide 10 IU Oxytocin IM (deltoid) to the  Once with feeding cues, ask the mother to encourage her
mother newborn to move toward the breast
4. Cut the cord close to the plastic clamp
5. Observe for oozing blood CONTINUATION: NON–SEPARATION
– Delay cutting until pulsation stop When the NB is ready, advise the mother to:
 Allows as much as 100ml of blood to pass from the a. Make sure the NB’s neck is neither flexed nor twisted
placenta into the fetus b. Make sure the NB is facing the breast, w/ the NB’s nose
 Ensures adequate RBC & WBC count in newborn opposite her nipple & chin touching the breast
– DO NOT milk the cord towards the baby c. Hold the NB’s body close to her body.
– Cut the cord close to the plastic clamp so that there is d. Support the NB’s whole body not just the neck & shoulders
no need for a 2nd “trim” e. Wait until her NB’s mouth is opened wide
– DO NOT apply any substance onto the cord f. Move her NB onto her breast, aiming the NB’s lower lip well
below the nipple
CORD CARE g. Look for signs of good attachment & suckling:
 DRY CORD CARE  Mouth wide open
– Wash Hands  Lower Lip turned outward
– Fold diaper below stump, keep cord stump open to  Baby’s chin touching breast
keep it dry  Suckling is slow, deep w/ some pauses
– If stump is soiled, wash with water and soap  If the attachment or suckling is NOT good, try again &
– Explain to the mother that she should seek medical reassess
attention if umbilicus is red or draining pus.
– Teach the mother to treat local umbilical infections 3  Mother moved onto a stretcher with her baby and
times a day transported to Recovery Room, mother –baby ward or
 DRY CORD CARE IS RECOMMENDED private room
– DO NOT apply any substance onto the cord  Breastfeeding is continued
– Faster sloughing  Proper Latching On/ Position/Benefits/Breast care
– DO NOT use a binder or “bigkis”
– Observe for the oozing of blood EVERY NEWBORN HAS NEEDS
– If blood oozes, place a second tie between the skin & to Breathe Normally, to be Warm, to be Protected, to be Fed
the clamp
SUMMARY:
D. NON–SEPARATION OF NEWBORN FROM MOTHER 1. Within 30 seconds Objective: Dry the baby
FOR EARLY BREASTFEEDING – To stimulate breathing, provide warmth
For Early Breastfeeding – 90 minutes – To prevent Hypothermia
1. Leave the newborn in skin-to-skin contact 2. After Thorough Drying Objective: Skin to Skin Contact
2. Observe for feeding cues (tonguing, licking, rooting, sucking) (SSC)
3. Encourage the mother to nudge the newborn towards the – To provide warmth and bonding
breast – To prevent Hypoglycemia and Infection
4. Counsel on positioning, attachment, and sucking 3. Up to 3 minutes Post–Delivery Objective: Timely Cord
 Mouth wide open, lower lip turned outwards Clamping and Cutting (CCC)
 Baby’s chin touching breast – To prevent anemia in term and pre–term; IVH and
5. Weighing, bathing, eye care, examinations, injections (Hepa transfusions in pre–term
B, BCG, Vitamin K) should be done after the 1st full 4. Within 90 minutes of Age Objective: Non–Separation of
breastfeed is completed Newborn from Mother
– DO NOT throw away colostrum
– To encourage initiation of breastfeeding through
sustained contact
 NEWBORN ASSESSMENT (Circumoral)
INDICATIONS The heart rate is The heart rate
 FIRST EXAMINATION: Monitoring the baby inside the womb of the less than 100 is more than
Pulse No heartbeat,
mother before the delivery and 2 to 4 hours after birth beats per minute 100 beats per
(Heart 0 heart rate
– Comprehensive knowledge of pregnancy, labor and delivery is (bpm) minute (bpm)
Rate)
being required and very essential in understanding the
Infant cries,
significance of physical findings in the newborn
Grimace No response There is grimacing coughs or
 SECOND EXAMINATION: Performed before discharge
(Reflex to stimulation in response to sneezes on
– 24 hours is the minimum stay to the hospital for both mother
Irritability) stimulation stimulation
and the newborn
– Systematic approach that helps to ensure that pertinent data If the infant is
are not overlooked If the muscle If the infant in active
– All the things in newborn will be assessed after the baby is tone is Loose demonstrates motion with
Activity
delivered (absent) and some tone and flexed muscle
(Muscle
 THIRD EXAMINATION: After 6 – 8weeks of neonatal life floppy flexion tone that
Tone)
– Follow up consult with the Pediatrician including the schedule without resists
of vaccinations but not mandatory for newborn but strongly activity extension
encourage less than 30 more than 30
– Immediate vaccination is Hepa B and BCG If respirations are Infant is crying
Respiratory Infant not
Effort breathing slow and vigorously,
PHASES OF ASSESSMENT irregular, weak or good and
1. INITIAL ASSESSMENT (Breathing)
gasping strong
 The Nursing Goal for the newborn is to give care including:
– Establish and maintain a patent airway which is the most
SCORE INTEPRETATION NURSING INTERVENTION
important thing because it is the first time for the newborn to
Immediate
breathe on his/her own
0 to 3 Severely Depressed Resuscitation
– To ensure the safety of the newborn to prevent injury and
infections Moderately Depressed
– Maintain warmth to prevent Hypothermia, because once the 4 to 6 Guarded Suctioning
newborn is delivered, they will encounter changes in Good Prognosis Proceed to Routine
temperature Excellent Condition Newborn Care
7 to 10
 The vernix caseosa is oil–based and cheese – like
substance that will add up to keep the baby warm
APGAR SCORING SYSTEM
– Initial Assessment that is performed in the 1st minute of life of the
APGAR SCORING
newborn, then the second one is on the 5th minute of the extra
 APGAR was developed in 1952 by Dr. Virginia Apgar, an
uterine life
Anesthesiologist at Columbia University
– The extra 10th minute is no longer mandatory if the first two
 Through the years, APGAR, becomes a useful mnemonic to
results lower than 6, take the 10th minute APGAR Scoring
describe the components of the score: Appearance, Pulse,
– Immediate initiation of respiration and changes in the circulatory
Grimace, Activity, and Respiration
patter is essential for the extra uterine life because breathing for
 The score is a rapid method for evaluating neonates immediately
newborn after delivery is the primary concern during the extra
after birth and in response to resuscitation
uterine life
 Apgar Scoring remains the accepted method of assessment and is
endorsed by both American College of Obstetrics and
WHEN TO DO THE APGAR SCORING?
Gynecologists and American Academy of Pediatrics
 FIRST MINUTE: To assess the general condition of the Newborn
 APGAR Scoring is recorded in all newborn infants at 1 minute
– It determines how well the baby tolerated the birthing
immediately after birth and 5 minutes interval
process
 FIFTH MINUTE: To assess Newborn’s adaptation
– It is a rapid method for assessing a neonate immediately after birth
– It tells the health care provider how well the baby is doing
in response to resuscitation
outside the mother’s womb because it reaches 5 minutes
– It is designed to assess the need for intervention to establish
outside the mother’s womb/how much the baby tolerating
breathing in 1 minute
extra uterine life
– It is designed to assess for signs of hemodynamic compromise such
 TENTH MINUTE: If the 5th minute APGAR is score is less than 4
as:
– This is optional if the baby is doing well and no signs of fetal
1. Cyanosis (bluish–purple color of the skin)
distress, but if there is evidence that APGAR Score remains
2. Hypoperfusion (which include low blood pressure, heart
low, the baby will suffer neurological change/damage
failure or loss of blood volume)
3. Bradycardia (slow heart rate)
 This test checks a baby's heart rate, muscle tone, and other signs
4. Hypotonia (decreased muscle tone)
to see if extra medical care or emergency care is needed
5. Respiratory depression or apnea
 Health Care Professionals use this assessment to quickly relay the
status of a newborn's overall condition
APGAR 0 1 2
 Low Apgar scores may indicate the baby needs special care, such
If the infant body as extra help with their breathing
is pink, but the
extremities are 2. TRANSITIONAL ASSESSMENT
Appearance If the infant is If the infant is
blue  1ST STAGE: Lasts for 6 hours, first 30 minutes awake and remaining
(Skin Color) blue or pale entirely pink,
(Acrocyanosis), or hours the newborn will be sleeping
no cyanosis
the mouth or lips  2ND STAGE: 6 – 12 hours observation should be made until the vital
turn blue signs are established
 – Period of instability during the first 6 to 8 hours of life through – Normal: 120 – 160 bpm
which all the newborn has to pass regarding of their – Bradycardia: less than 120 bpm
gestational age or the nature of labor and delivery – Tachycardia: more than 160 bpm
– Following the initial response, the newborn normally become
quiet 4. BLOOD PRESSURE: Blood pressure monitoring is not routinely
– The first sleep post – partum is called SLEEP PHASE which done. The average systolic and diastolic pressure is 66/44mmHg at
occurs within 2 hours of birth 1 – 3 days of age
– The Second Phase now starts when the newborn awakens
after 6 to 12 hours marked by hyper responsiveness to stimuli  MECONIUM: The first stool and passed out after 24 hours to 48
hours after birth
3. ASSESSMENT OF GESTATIONAL AGE  TRANSITIONAL STOOL: After 48 hours the stool on the 2nd or 3rd
– BALLARD SCORE is commonly used to determine gestational age. day of life, it will become greenish stool with diarrhea effect
Scores are given for 6 physical and 6 nerve and muscle  On the 4TH DAY OF LIFE if the newborn is breastfed, the pass out
development (Neuromuscular) signs of maturity of stool is 3 to 4 times a day and the color is yellow and smells like
– The scores for each may range from 1 to 5 sweet smelling because the breastfeed is high in lactic acid
– The scores are added together to determine the baby's gestational  If the newborn is bottle feeding, 2 to 3 times of passing out stool
age and the color is bright yellow and it has strong odor because of
 Neuromuscular Maturity: It include posture, square window, external factors involved
arm recoil, popliteal angle, scar sign, heal to ear
 Physical Maturity: Skin, lanugo, plantar surface, breast, ANTHROPOMETRIC MEASUREMENT
eye/ear, genitalia (male/female) Head HC: 33 to 35 cm – 1 finger breath from eyebrow
Chest CC: 31 to 33 cm – Nipple Line
1. SMALL FOR GESTATIONAL AGE (SGA): The newborn is less than Abdome AC: 31 to 3 cm – Umbilical Line
10% of the ideal weight at the time of birth, less than 2500 gms n
– The baby is less than 2,500 grams but the baby should more Length BL: 47 to 54 cm – Posterior Fontanelle up to the heel of
than 500 grams the foot following contour of newborn’s body
– < 5oo grams, the baby will consider abortus and most of them Weight WT: 2.5 to 4 kg, 5.5 to 8.8 lbs, 2500 to 4000 g
will die
2. LARGE FOR GESTATIONAL AGE (LGA): The newborn is more than 1. HEAD CIRCUMFERENCE: 33 – 35.5 cm
90% of the ideal weight at the time of birth, more than 4000 gms – The tape measure is placed at the back of the head into the
– The baby is more 4,000 grams – Macrosomia, most of them forehead, measure just above the eyebrows
were born from mother with gestational diabetes mellitus 2. CHEST CIRCUMFERENCE: 31 – 33 cm
3. APPROPRIATE FOR GESTATIONAL: (AGA): The newborn is within – Placed the tape measure over the nipples
the ideal range of birth weight of 2500 – 4000 gms 3. ABDOMINAL CIRCUMFERENCE: 31 – 33 cm
– Approximately 2,500 to 4,000 grams (2.5 kg) – From the chest slide it downward into the abdomen, measure
just over the umbilicus
1. FULL TERM: Pregnancy that reached 37 to 40 weeks age of – The chest and abdomen are smaller around 2 to 3 cm than the
gestation head
2. PRE–TERM: Pregnancy that reached 21 to 36 weeks age of 4. BODY LENGTH: 47 – 54 cm
gestation and below but not more than 20 weeks – Measure the length of the baby from heel to head of the baby
3. POST–TERM: Pregnancy that has extended up to or beyond 42 5. BODY WEIGHT: 2500 – 4000 gms (2.5 kg)
weeks of gestation – The birth weight may vary depending on the race, nutrition of
the mother, on the intra uterine life the fetus experience, and
4. GENERAL PHYSICAL EXAMINATION the genetic factors
Vital Signs:
1. TEMPERATURE: Can be taken through rectal (to check also for the MEDICATIONS
patency of the anus) or axilla 1. CREDE'S PROPHYLAXIS
– Normal: 36.5°C to 37.4°C – Erythromycin Ophthalmic Ointment
– Hypothermia: less than 36°C – Terramycin
– Hyperthermia: more than 38°C – Applied from inner to outer canthus of the eyes
 To prevent Ophthalmia Neonatorum
2. RESPIRATION: Count by observing the abdominal movements and 2. BCG (BACILLUS CALMETTE GUERINE)
count in one full minute for accuracy – Dosage & Route: 0.05 mL, ID Deltoid (R)
– Triggered by Physical, Sensory, and Chemical Factors  To prevent lung TB infection, TB Meningitis, Miliary TB
– Observe the rise and fall of the abdomen in the newborn 3. HEPA – B
PERIODIC RESPIRATION: If the newborn is able to experience – Dosage & Route: 0.5 mL, IM
periodic Apnea for less than 15 seconds, this is a normal finding – Site: Vastus Lateralis
– Normal: 30 to 60 cpm 4. VITAMIN K
– Tachypnea: more than 60 cpm  Promote blood clotting
– Bradypnea: less than 30 cpm  Prevent bleeding
 Prevent Hypofibrinogenemia
 The newborns are obligatory nose breather, the reflex response to – Drug Of Choice: Phytomenadione, Aquamephyton
nasal obstruction – Route: Intramuscular
 The newborns are able to breathe through the mouth when they – Site: Left–Vastus lateralis (common) or Rectus Femoris
cry or 3 weeks or more after birth (alternative site)
– Dosage:
3. PULSE: You may use the apical pulse which is located on the  Preterm – 0.05 CC
midclavicular between 4th and 5th inter coastal space left. Count in  Full Term – 0.1 CC
one full minute for accuracy
 Post – Term – 0.1 CC